Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17779 | MA |
NPI | 1114114980 |
---|---|
Provider Name | Dr. L. David Gassiraro |
First Address | West Roxbury, MA 02132-1747 |
Second Address | West Roxbury, MA 02132-1747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 26/09/2007 |